Headache: what makes a headache serious?

Headaches are very common and have many causes. Although they are a frequent source of stress and anxiety, headaches are only very rarely a sign of serious illness.

Many headache sufferers worry about having a brain tumour, but this is a very uncommon event. There are many different types of headaches, including tension headaches, sinus headaches, migraine headaches and cluster headaches.

Tension headaches

The most common cause of pain in the head is tension headache. According to the World Health Organization, this type of headache affects more than one-third of all men and more than half of all women. These headaches are usually felt as a dull pain on both sides of the head, or as a feeling of having a tight band around the forehead.

Tension headaches usually appear around times of stress. They may come on with tiredness and sometimes after prolonged reading. Taking exercise or drinking alcohol does not usually make these headaches any worse.

Tension headaches were previously thought to be due to contraction (tightening) of the neck muscles, but research now suggests this is not the cause. In fact, the exact cause is not known.

For tension headache treatment, simple over-the-counter painkillers such as ibuprofen, paracetamol or aspirin usually provide relief. (Aspirin should not be used in children aged 16 years and younger).

Hot showers, stretching and massage may also help. Chronic sufferers should beware of becoming too reliant on painkillers and look for ways of relaxing and avoiding stress.

Sinus headaches

Sinus headache is a common problem, which many people will recognise, particularly when they have a bad cold or flu. A ‘stuffy’ head and pain above or behind the eyes, or on either side of the nose, are the usual symptoms. Pain is often worse when the head is bent forward or when lying down.

Migraine headaches

Migraine is a common cause of headache, affecting at least one in 7 people. Migraines are about 3 times more common in women than in men. Migraine headaches are often throbbing, one-sided, associated with nausea (feeling sick) and vomiting, and worse with bright light and noise.

Specific migraine treatment options are available. Many attacks can be relieved by taking medicines as soon as symptoms start and lying down in a dark, quiet place.

Cluster headaches

Cluster headaches are a rare type of headache, affecting men much more than women. Cluster headaches are one sided, and are usually felt around the eye. The pain is usually intense. There may be a feeling of a blocked or runny nose and a watery eye on the affected side.

Cluster headaches can be brought on by alcohol. They may occur frequently, up to several times per day for weeks or months at a time (in a ‘cluster’), and then disappear for months or even years. Cluster headaches often occur at night, and tend to last between 15 minutes and 3 hours.

When to see your doctor

Despite this wide variety of non-serious headaches, sometimes a headache will be a sign of serious disease. See your doctor if any of the following applies to you:

you start getting regular headaches, especially if you are aged 50 years or over;

you get a sudden severe headache ‘out of the blue’ that may be accompanied by a stiff neck;

you have a constant headache that is gradually getting worse over days or weeks;

you develop a severe headache accompanied by fever, nausea or vomiting;

you have a headache together with drowsiness, confusion, or memory loss;

you have a headache following a head injury;

you have a headache together with loss of sensation or weakness in any part of your body;

you have a headache together with blurred or double vision, slurred speech or difficulty speaking;

you have a headache associated with coughing, physical exertion or sexual activity;

you have two or more headaches in a week;

you have a headache associated with being short of breath; or

you develop a headache that is associated with convulsions (fits).

You should also see your doctor if you have headaches that are different from or worse than other headaches you have experienced. Indeed, any headache that is worrying you warrants a visit to your doctor.

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